Stenting for caustic strictures: esophageal replacement replaced.
METHODS
From 1983 to 1996, 31 children with caustic esophageal strictures were seen at Bambino Gesù Children's Hospital; they were all treated conservatively except for two cases complicated by tracheoesophageal fistula. The remaining 29 patients were divided into three groups depending on the treatment, which was modified over the years. Group A (1983 to 1987) consisted of seven patients treated by periodic dilatations; group B (1988 to 1992) consisted of 10 children treated by 40 days of esophageal stenting plus dexamethasone, 0.5 mg/kg/d plus ranitidine plus no oral feeding for 7 to 10 days; group C (1993 to 1996) consisted of 12 cases treated by 40 days of esophageal stenting plus dexamethasone, 1 mg/kg/d plus omeprazole plus early oral feeding resumption.


RESULTS
No differences were observed between the three groups of patients with regard to the mean age and to the ingested substance, whereas a significant difference (P = .007) was observed in the mean length of the stricture between group A and C (3.4+/-1.3 and 5.6+/-1.6 cm, respectively). In all but one of the patients (96.5%) complete healing of the stenosis was achieved by conservative treatment, with definitive relief of dysphagia. One patient in group C did not improve after a repeated stenting procedure and was surgically treated. However, in group A, resolution of the stricture was obtained after an average of 19.9+/-14.8 dilatations in a mean period of 25.3+/-17.2 months. In group B, a mean of 12+/-11.3 dilatations were required in a mean period of treatment of 14.1+/-10.6 months. In patients in group C, a mean of 3.5+/-3.2 dilatations were necessary in a mean of 5.8+/-4.8 months. A statistically significant difference was observed both with regard to the number of dilatations and to the duration of treatment, between group A and group C (P = .002) and group B and C (P = .03).


CONCLUSIONS
Esophageal replacement should be considered only in cases complicated by tracheoesophageal fistula or in the rare patients who do not respond to repeated esophageal stenting.
De Peppo
F
F
Department of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
Zaccara
A
A
Dall'Oglio
L
L
Federici di Abriola
G
G
Ponticelli
A
A
Marchetti
P
P
Lucchetti
M C
MC
Rivosecchi
M
M
D000900:Anti-Bacterial Agents; D002057:Burns, Chemical / Q000628:therapy*; D016022:Case-Control Studies; D002404:Catheterization; D002675:Child, Preschool; D003907:Dexamethasone / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004940:Esophageal Stenosis / Q000139:chemically induced* / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D009853:Omeprazole / Q000627:therapeutic use; D011899:Ranitidine / Q000627:therapeutic use; D012826:Silicone Elastomers; D015607:Stents; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D012826:Silicone Elastomers; D003907:Dexamethasone; D011899:Ranitidine; D009853:Omeprazole